DPP-4 inhibitors, like GLP-1 agonists, are part of a larger class of type 2 diabetes drugs called incretin mimetics. However, they differ from GLP-1s in that they are taken exclusively by mouth. And, instead of promoting more GLP-1 protein production directly, they block an enzyme called Dipeptidyl peptidase-4 that normally deactivates GLP-1.

The effect of these drugs is similar in that they promote insulin production and slow glucose from being absorbed into the blood.

• Januvia
• Janumet
• Tradjenta
• Onglyza
• Nesina.

Like the GLP-1 incretin mimetics, DPP-4 drugs have also been linked to a number of serious health concerns, including heart failure, joint pain, inflammatory bowel disease and pancreatic cancer.

Like the GLP-1 incretin mimetics, DPP-4 drugs have also been linked to a number of serious health concerns, including heart failure, joint pain, inflammatory bowel disease and pancreatic cancer.

• Invokana (canagliflozin)
• Farxiga (dapagliflozin)
• .Jardiance (empagliflozin).

Unfortunately, SGLT2s have also been linked to serious health risks in recent years, such as kidney damage, ketoacidosis, lower limb amputations, urinary tract infections and bone fractures.

Insulin is the required treatment for patients with type 1 diabetes. It is often also used by those with gestational diabetes, as well as those with type 2 diabetes that don’t respond to other treatment options.

As such, it makes up the majority of the diabetes drug market. Insulin is almost always injected, since it is neutralized by the stomach if taken orally.  There are also versions that can be inhaled as a powder.

While insulin treatments were historically derived from the pancreas of cows, pigs, horses or fish, these have been almost completely replaced in the United States by biosynthetic versions of human insulin called insulin analogues. Insulin analogues are categorized based on how quickly they take effect and how long they last.

Rapid-acting insulin analogues usually start working within 10 to 30 minutes but only last for between 1 to 5 hours.

• Humalog (insulin lispro)
• Novolog (insulin aspart)
• Apidra (insulin glulisine).

Short-acting insulin analogues, or regular insulin, can take effect within 30 minutes to 1 hour from injection, and last from 2 to 8 hours.

• Humulin R
• Novolin R
• Regular insulin.

Intermediate-acting insulin takes effect after about 1 – 2 hours, and last for 18 to 24 hours.

• Insulin isophane
• NPH insulin
• Humulin N
• Novolin N.

Long-acting insulin analogues have seen much improvement in recent years, and can now take effect in as little as 30 minutes while lasting up to 42 hours. These are usually used along with a short-acting insulin around meal times.

• Basaglar (insulin glargine)
• Lantus (insulin glargine)
• Toujeo (insulin glargine)
• Levemir (insulin detemir)
• Tresiba (insulin degludec).

Premixed analogues are combinations of intermediate and short-acting insulin in one formulation, with the label describing the percentage of each. These are designed to provide rapid onset with longer effectiveness. They can take effect in as little as 10 minutes and last up to 24 hours.

• Humulin 50/50
• Humulin 70/30
• Novolin 70/30
• Novolog 50/50
• Novolog 70/30
• Humalog 50/50
• Humalog 75/25.

Finally, a new rapid-acting inhaled insulin analogue called Afrezza was recently approved that allows patients to forgo injections around meal times as long as they have also taken a long-acting insulin. It can work in as little as 15 minutes and last for up to 3 hours.

Sulfonylureas are a class of drugs first discovered in the 1950s that have been used for decades to treat type 2 diabetes. These compounds promote the beta cells in the pancreas to release more insulin, as long as it is still being produced.

Due to their propensity toward certain side effects, the first generation of sulfonylureas have been largely updated and replaced by second-generation formulations.

However, certain side effects like low blood sugar, weight gain, gastrointestinal distress and headaches are still associated with these drugs and their use is limited. Some common sulfonylureas include:

• Glucotrol
• Amaryl
• Diamicron
• Glurenorm
• Gliben-J
• Daonil
• Diabeta
• Glidanil
• Glynase.

Thiazolidinediones, also known as glitazones, are a class of drugs first introduced in 1999 that were extremely popular in the treatment of type 2 diabetes until recent years.

They work by lowering the amount of fatty acids in the bloodstream, thereby prompting the body to burn excess glucose for energy.

Two thiazolidinediones that were widely used around the world are:

• Actos (pioglitazone)
• Avandia (rosiglitazone).

However, the sale of both drugs was restricted in the United States or Europe in recent years due to health concerns. Avandia was initially linked to heart attacks and cardiovascular injuries but recently relisted by the FDA. Actos was linked to bladder cancer and heart attacks, leading to bans in France and Germany.

Alpha-glucosidase inhibitors are oral medications for the treatment of type 2 diabetes that block the action of the alpha-glucosidase enzymes in the small intestine.

This reduces the digestion and absorption of carbohydrates and simple sugars into the bloodstream that can raise glucose levels.

The use of these drugs is limited in the United States in comparison to other diabetes treatments since they are considered less potent at lowering blood sugar in the Western diet. The most commonly used drugs are:

• Precose (acarbose)
• Glyset (miglitol)
• Basen (voglibose).

Meglitinides are a class of drug prescribed to treat type 2 diabetes that were first introduced in 1997. They work by binding to and promoting potassium in the cells of the pancreas, thereby increasing the production of insulin.

Meglitinides have been associated with weight gain and low blood sugar, however not to the same extent as sulfonylureas. Repaglinide has also been shown to cause cancer of the thyroid and liver in test animals.

The most popular forms of meglitinides include:

• Prandin (repaglinide)
• Starlix (nateglinide)
• Glufast (mitiglinide).

Metformin, which is the only drug in the biguanides class still used, is one of the oldest and most widely used drugs in the world for type 2 diabetes. Due to its effectiveness, low price and positive tolerance in most patients, it is considered a first line drug for diabetes and is among the drugs on the World Health Organization’s List of Essential Medicines.

Metformin works by inhibiting the production of glucose in the liver and making the rest of the body more sensitive to the effects of insulin.

While it has minor side effects of diarrhea, nausea, abdominal pain and low blood sugar, it has also been shown to have positive effects on cardiovascular disease and the ability to fight cancer.

Some of the more popular versions of Metformin sold in the United States include:

• Glucophage
• Glucophage XR
• Riomet
• Diabex
• Carbophage
• Diaformin
• Glumetza
• Fortamet.

In addition, metformin is often combined with other type 2 diabetes drugs to form new compounds such as Janumet, Kombiglyze, Avandamet and Kazano.

Focus on diets high in whole grains, vitamins and leafy greens, as well as fewer carbohydrates, processed foods, salt, alcohol and red meat.

Regular exercise helps fight obesity, one of the known causes of type 2 diabetes. It also helps the effectiveness of insulin, increases heart health and reduces blood pressure and glucose levels.

During times of high stress, your body will raise adrenaline, which in turn increases blood sugar levels, blood pressure and the risk of heart disease. Also, stress often leads to unhealthy diets, alcohol use or smoking.

Joining a group to help reach goals and maintain healthy diet and exercise practices can keep you on track and committed. This is especially true if someone you live with agrees to make lifestyle changes at the same time.